【摘要】 目的探讨舌下含化硝酸甘油倾斜试验中个体化给药对试验结果的影响。方法设观察组161例按0.3mg/60kg计算,根据体质量大小增减给药量;对照组231例,每例不论体质量大小给硝酸甘油0.3mg舌下含化,比较两组间阳性率、阳性反应类型、阳性患者心律失常和晕厥的发生率。结果阳性率:观察组高于对照组65.84%(106/161)vs42.86%(99/231),P<0.01;阳性反应类型:血管抑制型观察组低于对照组32.08%(34/106)vs55.56%(55/99),P<0.01,心脏抑制型两组间无显著差异,4.72%(5/106)vs7.07%(7/99),P>0.05,混合型观察组明显高于对照组63.21/%(67/106)vs37.37%(37/99),P<0.005;心律失常比较:两组间无明显差异,45.28%(48/106)vs43.43%(43/99),P>0.05,均以缓慢性心律失常为主,窦性心动过缓观察组40例占37.74%(40/106),心率小于50次/min者28例,其中窦性停搏8例,对照组32例占32.32%(32/99),心率小于50次/min者10例,其中窦性停搏2例,观察组交界区逸搏心律的发生率明显低于对照组3.77%(4/106)vs10.10%(10/99),P<0.01,窦性停搏的发生率高于对照组7.55%(8/106)vs2.02%(2/99),P<0.05;晕厥的发生率高于对照组23.58%(25/106)vs11.11%(11/99),P<0.05。结论①个体化用药能明显提高血管迷走性晕厥的敏感性;②个体化用药的阳性反应程度较重,以混合型为主;③阳性反应者均以缓慢性心律失常为主,窦性停搏的发生与硝酸甘油的用量、反应持续的时间和终止试验的速度有关;④严格掌握硝酸甘油的用量,及早发现血压和心率的下降趋势,快速终止试验可避免晕厥和缓慢性心律失常的发生。更多还原

【Abstract】 Objective To explore effect of test result dosage individuation in sublingual nitroglycerine provocation head-up tilt table test.Methods Patients with syncope unknown origins were divided into observation group and control group.161 cases in observation group were given nitroglycerine dosage that was calculated by 0.3 mg/kg and increase or decrease according to weight.No matter 231 cases in control group each case the body weight size were given dosage for 0.3 mg/kg.Compared with positive rate、positive response type、arrhythmic events and syncope rate of the two groups.Results Positive rate is significant higher in observation group than in control group,65.84%vs42.86%,P<0.01;Positive response type:vasodepressor response in observation group is lower than in control group 32.08%vs55.56%,P<0.01.There is no significant difference in cardioinhibitory response between the two groups 4.72%vs7.07%,P>0.05.Mixed type is significant higher in observation groups,63.21 %vs37.37%,P<0.01.Arrhythmic events:There is no significant difference between the two groups.45.28%vs43.43%,P>0.05.Bradarrhythmias was more common both them.40 case bradycardia in observation group is 37.74%,28 case of them heart rate is lower than 50 bpm and 8 cases sinus pause among them.32 case bradycardia in control group is 32.32%,10 case of them heart rate is lower than 50 bpm and 2 case sinus pause among them.junction escape rhythm in observation group is significant lower,3.77%vs10.10%,P<0.01.While sinus pause rate and syncope rate were higher in observation group,7.55%vs2.02%,P<0.05,23.58%vs11.11%,P<0.05.Conclusion ① Sublingual nitroglycerine dosage individuation can enhance sensitivity of vasovagal syncope.② Positive response symptom were more heavy and by mixed type primarily.③ Bradyarrhythmias were common in patients of positive response.occurrence of sinus pause is relate to nitroglycerine dosage、positive response continued time and speed of stop test.④Control rigorously nitroglycerine dosage,discover drop trend of blood pressure and heart rate earlier then stop test immediately.Can avoid occurrence of syncope and Bradyarrhythmia.更多还原